Contract Details
Ancillary Care Services
Facility name
G.G. Medical
Provider ID
P000004587
NPI
1457398794
Tax ID
742612480
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1223 East Euclid Avenue Suite 1
San Antonio, TX 78212
United States
County
Bexar
Phone
2102250607 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address